February 28, 2019 at 2:03 PM
Both an infant and childhood complaint, and typically seen in babies under 1 year old, torticollis is otherwise known in the older child as ‘wry neck’, and is often caused by minor injury or trauma. Symptoms usually present when children complain of pain and hold their head to one side, often refusing to move their head or turn their neck. Sometimes they may simply wake up with it and no cause can be linked.
These presentations can be somewhat alarming and worrying for both parent and child. It is also important to note that other systemic symptoms may also occur, and medical attention should be sought if the above is in combination with any additional symptoms of dizziness, blurred vision, persistent night pain or vomiting and any weakness of the limbs (keep in mind that this list is not exhaustive).
The usual course of this presentation can last between 7-10 days including pain and restricted movement. Essentially, torticollis is a spasm of the sternocleidomastoid muscle of the neck. This muscle attaches from the furthest point behind the jaw bone diagonally down to the clavicle at its endpoint in the centre of the body. There is one on each side of the neck which allows the head to rotate to either side as well as allows tilting movements (ear to shoulder).
The first step for management of this complaint is typically to visit your GP or in some cases, the acute care facilities or the emergency department. From there, you should be referred to a physiotherapist that specializes in paediatric patients, such as I do, in order to provide the child with hands-on treatment and strengthening exercises relevant to the condition, as well as prevent further pain or occurrence. In some cases, an xray is performed to check the bony alignment but this would only be of concern specifically if trauma has occurred. A scan would be the next test required if in combination with other symptoms of concern as mentioned above.
Regular and consistent pain relief is the most helpful management in the acute phase in order to allow rest and for the muscle to relax. Ice and/or heat can also be helpful during this time. Following this, gentle active movement within the limits of pain is encouraged. You may find your child twisting and turning strangely to achieve and access sufficient movement, but as the pain eases, the movement should improve.
The child should only return to sport or activity only once they regain full normal range of their neck movement that is pain-free. Normally, torticollis occurs in isolation and is a one-off event although some children have presented on a second occasion and this may warrant continued physiotherapy intervention to regain full strength and flexibility for the muscles around the neck.
If you have a significant concern please seek a qualified paediatric trained physiotherapist who can assess your child, and can sufficiently determine the cause and/or refer on for further investigation should this be required.
Eloise is a Senior Paediatric Physiotherapist, with over 12 years of experience working with children of all ages from birth to 16 years with respiratory, neurological and musculoskeletal conditions. To book an appointment with Eloise click here.